Healthcare Provider Details

I. General information

NPI: 1255973194
Provider Name (Legal Business Name): DEBORAH ANN EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH ANN SMITH

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 W SUNSET BLVD
LOS ANGELES CA
90029-2174
US

IV. Provider business mailing address

424 CHRISTOPHER CT
RIDGECREST CA
93555-6009
US

V. Phone/Fax

Practice location:
  • Phone: 310-388-7983
  • Fax:
Mailing address:
  • Phone: 909-515-0441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC16169
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC16969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: